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C&p Reduction?


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8 replies to this topic

#1 seapup

 
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Posted 03 July 2012 - 05:43 PM

Just had my C&P reduced from 40% to 20% stating my sight got better. Have had surgery on this SC issue twice. I was totally stunned by this result. I entered the Navy in 72 with perfect sight then upon discharge had change in vision along with pterygium in one eye. Noted in records as SC but no compensation awarded when discharged as it stated it was not warranted. Now, fast forward to 85 had surgery on right eye to remove pterygium and now have another growing in left eye. Now to 2004 had surgery on left eye for pterygium that was causing problems with cornea nothing more can be done to right eye as the astigmatism, cornea scarring cannot be fixed. Now 2005 found old service records stating my SC so I filed then for C&P and was awarded 10%, then re-applied in 2007 for increase they found previous ruling was a CUE awarded 40%. Now applied for increase in 2010 nothing given as things were slightly better. Now 2012 I applied yet again for increase and they reduced my award from 40% to 20% stating vision is better. How can they reduce it? Vision is still bad cannot read small print have to have wife or someone else read for me. Cannot drive at night since I cannot see the signs or markings on the road. I can drive during the day if the weather is good. If it rains my vision is extremely impaired. The cornea is wrinkled on both eyes and astigmatism is on both eyes now as well. Only have 60 days for rebuttal and I am extremely upset at this development. Eyes are not gonna get better unless I have a transplant and there is no guarantee that it will take and with diabetes it is even more risky. Diabetes SC has been denied with the "Boots on the ground" issue even though I was in the gulf of tonkin. Hearing is also, SC but not severe enough yet to get compensation. What is the best way to fight this...if attorney is needed any suggestions on who to get in Calif.

Thanks

#2 Berta

 
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Posted 04 July 2012 - 05:30 AM

I replied to this in the Lawyers topic here:

Diabetes SC has been denied with the "Boots on the ground" issue even though I was in the gulf of tonkin. "

Have you checked the most recent AO ship's list from VA?

http://www.publichea...iplist/list.asp

Also, when Navy Times posted this info, a commenter in this link mentioned many carriers were in the Tonkin for many months,during the war.

http://www.navytimes...-guard-012112w/

You might need to consider getting an IMO from an eye specialist.

Are you able to scan and attach here, their Reasons and Bases for their decision? (Cover all identifying info)

An attorney ,if retained, might sure ask for the same thing,- an independent medical evaluation of your current condition.

#3 iraqx2

 
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Posted 04 July 2012 - 06:00 AM

Have you filed for any official Notice of Disagreement on all these times they were messing with your rating? And yes, on the issue of disputing the lowering of your rating, I would not hire a lawyer. Unless you really need to.

#4 jvretiredvet

 
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Posted 04 July 2012 - 11:51 AM

As I read your post, the examination associated with your 2010 claim for increase showed improvement (in your visual acuity?) thus no increase was granted. You then filed another request for increase in 2012 and the associated C&PE showed improvement (in your visual acuity?).

To answer your specific question though, How can they reduce it? .. yes they can propose to reduce the evaluation because you have had two examinations which do not show that a 40% (for decreased visual acuity?) due to pterygium is warranted. The rating criteria for pterygium based on visual acuity are at 38 CFR 4.79 http://www.benefits....PART4/S4_79.DOC using the analogous Diagnostic Code 6034-606x.

Some questions and thoughts:

a. This is the problem with requesting an increase - sometimes you don't get the increase and moreover you can put yourself in a position for a reduction.

b. As for difficulty reading, night driving, and so forth, they really aren't considered per the Rating Schedule.

c. What are your uncorrected visual acuities for each eye? This is to see if 38 CFR 3.383(a)(1) http://www.benefits....3/S3_383.Paired Organs http://www.benefits....ART3/S3_383.DOC is an issue.

d. I am presuming that you are service connected for pterygium of the right eye/cornea and that the left eye/cornea pterygium is not service connected ... is that correct? What are your corrected visual acuities for each eye?

e. Per 38 CFR 4.75(b) http://www.benefits.va.gov/warms/docs/regs/38CFR/BOOKC/PART4/S4_75.DOC , eye examinations are done by an optometrist or ophthalmologist. So, I'm pretty sure that you already have had specialist examinations.

f. Actually, I don't believe that you can file a Notice of Disagreement (NOD) at this time because an adverse action has not been taken, it has only been proposed.

g. The only way, at this moment, to stop the proposed reduction is to provide another examination that show different visual acuities. You might be able to get this done at your VAMC, but you might have to spring for it yourself with a civilian provider. Note: another exam may show essentially the same or perhaps even better acuities.

h. If the reduction does takes place, you can then file a NOD and ask for a Decision Review Officer (DRO) de Novo review. The DRO may - or may not - request another optometry/ophthalmology examination.

Just had my C&P reduced from 40% to 20% stating my sight got better. Have had surgery on this SC issue twice. I was totally stunned by this result. I entered the Navy in 72 with perfect sight then upon discharge had change in vision along with pterygium in one eye. Noted in records as SC but no compensation awarded when discharged as it stated it was not warranted. Now, fast forward to 85 had surgery on right eye to remove pterygium and now have another growing in left eye. Now to 2004 had surgery on left eye for pterygium that was causing problems with cornea nothing more can be done to right eye as the astigmatism, cornea scarring cannot be fixed. Now 2005 found old service records stating my SC so I filed then for C&P and was awarded 10%, then re-applied in 2007 for increase they found previous ruling was a CUE awarded 40%. Now applied for increase in 2010 nothing given as things were slightly better. Now 2012 I applied yet again for increase and they reduced my award from 40% to 20% stating vision is better. How can they reduce it? Vision is still bad cannot read small print have to have wife or someone else read for me. Cannot drive at night since I cannot see the signs or markings on the road. I can drive during the day if the weather is good. If it rains my vision is extremely impaired. The cornea is wrinkled on both eyes and astigmatism is on both eyes now as well. Only have 60 days for rebuttal and I am extremely upset at this development. Eyes are not gonna get better unless I have a transplant and there is no guarantee that it will take and with diabetes it is even more risky. Diabetes SC has been denied with the "Boots on the ground" issue even though I was in the gulf of tonkin. Hearing is also, SC but not severe enough yet to get compensation. What is the best way to fight this...if attorney is needed any suggestions on who to get in Calif.

Thanks



#5 Stretch

 
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Posted 04 July 2012 - 04:56 PM

I had a pterygium in my eye. The doctor told me that if it drifts toward the cornea I would have it removed or I would be in trouble with Vision problems. It moved toward the cornea almost touching it and then I had it removed.

#6 seapup

 
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Posted 05 July 2012 - 02:04 AM

SC was for both eyes at time of discharge but only had treatment in service for one eye but was noted that both eyes were a problem ie blurry vision, redness and unable to read for long periods.

Due to the surgery on the right eye twice the scarring has caused "astigmatism" eye looks like the shape of a football when photos were taken. This eye is basically going to be gone due to the astigmatism and pterygium which cannot be removed at this point as it is on the cornea.

Eye exam in 2010 notes: Pterygium BE, s/p pterygium surgery with iron line deposit, corneal scarring & irregular astigmatism RE > LE, s/p PTK RE for stromal scar.
Further states in "Assessment"
1. refractive error/presbyopia
2. diabetes with no retinopathy BE
3. choroidal nevi LE
4. mild cataracts BE
5. pterygium BE, s/p surgical removal with persistent corneal scarring and irregular astigmatism, h/o inability to adapt to contact lens wear

Slit lamp & external eye exam cornea: marked other, describe: pterygium RE, surface irregularity LE. Lens: describe: ant cortical opacities BE


C&P exam 2012 under "Corneal conditions" Does the veteran have another corneal condition that may result in an irregular cornea? (Fore example, pellucid marginal degeneration, irregular astigmatism from corneal scar, post-laser refractive surgery, acne rosacea keratopathy, etc.) Dr. says "NO". Previous notes from 2010 exam states other wise.

Next page of questions in C&P under cataract condition: "Preoperative (cataract is present) which is marked for BE then, it says : Is the Veteran's decrease in visual acuity or other visual impairment, if present, attributable to any of the eye conditions checked above in this section he says no. If no, explain: decrease due to high astigmatism. (I understand this to mean Cataract condition does not cause astigmatism).

Next page under "Functional impact" ... impact his/her ability to work? Dr. marked "YES" If yes, describe impact: "HIs borderline vision would limit him for many occupations".
Remarks if any: Cataracts are likely due to diabetes which has a high prevalence of cataracts.

Visual acuity: 20/200 RE, 20/100 LE (UC distance), UC near 5/200 RE, 5/200 LE, CD 20/50 RE, 20/40 LE, CN 20/100 RE, 20/70 LE.

Since, the reduction is being reviewed does this mean that the CUE "they found" before is now reversed and their own findings were wrong when they said it was a CUE???

As for the "Boots on the Ground" ship is not listed as of yet. I have been put on the AO list, had the exam etc but nothing more. When I went to file for this lastest C&P exam VA rep told me that my claim for AO exposure was denied before and it was a "dead issue". I can remember being able to see soldiers on the shore firing at our ship so we had to have been pretty close.

Going for a IMO in two weeks.

#7 Berta

 
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Posted 05 July 2012 - 09:54 AM

“Since, the reduction is being reviewed does this mean that the CUE "they found" before is now reversed and their own findings were wrong when they said it was a CUE??? “

I dont understand what you mean there-

a “proposed reduction” means just that- they intend to reduce your comp or already did.

Have you asked for a Hearing yet on this?

You could submit the IMO you get (if it is favorable and follows the IMO criteria here) hopefully within the 60 day deadline, and if not a hearing request made ASAP within the deadline would offer you an opportunity to submit the IMO then.

Sooner is far better then later in cases of a proposed reduction.

I handled one regarding my husband many years ago. They dropped the reduction idea when they got the NOD.

He didn't need an IMO and never requested a VA hearing because the VA's medical rationale in the reduction letter was absurd and also VA did not consider the appropriate regulations properly.

But your type of claim needs a strong IMO ,in my opinion.

If it doesn't follow the IMO criteria here in the IMO forum and the terminology as to “as likely as not” etc with a full medical rationale, the VA will give it no weight to combat the C & P exam results.

#8 jvretiredvet

 
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Posted 05 July 2012 - 11:28 AM

Most eye conditions (including pterygium) are evaluated on "corrected distance vision" per 38 CFR 4.76(b)(1) http://www.benefits....ts....9.DOC . Based on the 2012 examination, your evaluation for the bilateral pterygia would be 10%. From 38 CFR 4.79 DC 6034-6066:

Vision in one eye 20/50 (6/15):
In the other eye 20/50 (6/15)....................................................................................... 10
In the other eye 20/40 (6/12)....................................................................................... 10

Based on your statement that a reduction from 40% to 20% is proposed, I suspect that you have another, separate 10% evaluation someplace somewhere ... is that correct?

WRT Since, the reduction is being reviewed does this mean that the CUE "they found" before is now reversed and their own findings were wrong when they said it was a CUE??? No, that's not it means. I suspect that the CUE from 2007 was based on the fact that your eye condition earlier might have been evaluated on the basis of only eye being service connected, which the CUE corrected.

So, the CUE stands ... but the evaluation might not stand because a particular evaluation or rating level does not become permanent until that evaluation has been held for 20 years or more.

The problem, as I see it, is that you have two separate examinations (2110 and 2012) which showed improvement from the examination associated with your 2007 claim. It mighta been neat to see the exam results from 2007 (to include the corrected visual acuities) and also see the visual acuities from the 2010 examination, but that's kinda moot at this point.

SC was for both eyes at time of discharge but only had treatment in service for one eye but was noted that both eyes were a problem ie blurry vision, redness and unable to read for long periods.

Due to the surgery on the right eye twice the scarring has caused "astigmatism" eye looks like the shape of a football when photos were taken. This eye is basically going to be gone due to the astigmatism and pterygium which cannot be removed at this point as it is on the cornea.

Eye exam in 2010 notes: Pterygium BE, s/p pterygium surgery with iron line deposit, corneal scarring & irregular astigmatism RE > LE, s/p PTK RE for stromal scar.
Further states in "Assessment"
1. refractive error/presbyopia
2. diabetes with no retinopathy BE
3. choroidal nevi LE
4. mild cataracts BE
5. pterygium BE, s/p surgical removal with persistent corneal scarring and irregular astigmatism, h/o inability to adapt to contact lens wear

Slit lamp & external eye exam cornea: marked other, describe: pterygium RE, surface irregularity LE. Lens: describe: ant cortical opacities BE


C&P exam 2012 under "Corneal conditions" Does the veteran have another corneal condition that may result in an irregular cornea? (Fore example, pellucid marginal degeneration, irregular astigmatism from corneal scar, post-laser refractive surgery, acne rosacea keratopathy, etc.) Dr. says "NO". Previous notes from 2010 exam states other wise.

Next page of questions in C&P under cataract condition: "Preoperative (cataract is present) which is marked for BE then, it says : Is the Veteran's decrease in visual acuity or other visual impairment, if present, attributable to any of the eye conditions checked above in this section he says no. If no, explain: decrease due to high astigmatism. (I understand this to mean Cataract condition does not cause astigmatism).

Next page under "Functional impact" ... impact his/her ability to work? Dr. marked "YES" If yes, describe impact: "HIs borderline vision would limit him for many occupations".
Remarks if any: Cataracts are likely due to diabetes which has a high prevalence of cataracts.

Visual acuity: 20/200 RE, 20/100 LE (UC distance), UC near 5/200 RE, 5/200 LE, CD 20/50 RE, 20/40 LE, CN 20/100 RE, 20/70 LE.

Since, the reduction is being reviewed does this mean that the CUE "they found" before is now reversed and their own findings were wrong when they said it was a CUE???

As for the "Boots on the Ground" ship is not listed as of yet. I have been put on the AO list, had the exam etc but nothing more. When I went to file for this lastest C&P exam VA rep told me that my claim for AO exposure was denied before and it was a "dead issue". I can remember being able to see soldiers on the shore firing at our ship so we had to have been pretty close.

Going for a IMO in two weeks.



#9 carlie

 
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Posted 05 July 2012 - 06:05 PM

Ditto on what jvretiredvet has posted but will add you can put the reduction off
by request a hearing in writing and that no further action be taken on the proposal
to reduce prior to having the hearing (being provided with due process).

If you can obtain medical evidence by a provider with the correct pedigree,
that shows your vision to continue to fall into the criteria for the 40 percent
then that can keep the reduction from taking place.
JMHO